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Esophageal cancer recurrence rates after esophagectomy are high, and locally recurrent or distant metastatic disease has poor prognosis. Management is limited to palliative chemotherapy and symptomatic interventions. We report our experience of four patients who have undergone successful liver resection for metastases from esophageal cancer. All underwent esophagectomy and were referred to our unit with metastatic recurrent liver disease, two with solitary metastases and two with multi-focal disease. The patients underwent multidisciplinary assessment and proceeded to a course of neoadjuvant chemotherapy followed by open or laparoscopic liver resection. Three patients were male, and the mean age was 57.5 (range 44-71) years. Response to chemotherapy ranged from partial to complete response. Following liver resection, two patients developed recurrent disease at 5 and 15 months, and both had disease-specific mortality at 10 and 21 months, respectively. The other two patients remain disease free at 22 and 92 months. Recurrent metastatic esophageal cancer continues to have a poor prognosis, and the majority of patients with liver involvement will not be candidates for hepatic resection. However, this series suggests that in selected patients, liver resection of metastases from esophageal cancer combined with neoadjuvant and adjuvant chemotherapy is feasible, but further research is required to determine whether this can offer a survival advantage.

Cisplatin and nedaplatin show significant antitumor activity and have been widely used for esophageal squamous cell carcinoma (ESCC). However, it is still unclear whether the efficacy and safety of nedaplatin-based regimens are comparable to those of cisplatin-based regimens in patients with metastatic/recurrent or advanced ESCC. Therefore, we conducted a systematic review and meta-analysis to compare the efficacy and safety of these two regimens for the treatment of metastatic/recurrent and advanced ESCC. We systematically searched Pubmed, Web of Science, and the Cochrane Database, as well as abstracts presented at conferences (all up to January 2015), for randomized-controlled and nonrandomized clinical trials that compared cisplatin-based and nedaplatin-based regimens in patients with metastatic/recurrent or advanced ESCC. Data were extracted from the original studies by two independent reviewers. This meta-analysis was performed using Review Manager (RevMan) Version 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) software. Ten eligible trials, including 598 patients diagnosed with metastatic/recurrent or advanced ESCC, were included in our analysis. Our results demonstrated that the nedaplatin-based regimens were comparable to the cisplatin-based regimens in terms of overall survival (OS) (hazard ratio, HR: 1.22, 95% confidence interval, CI: 0.86–1.74, p = 0.26) and overall response rate (ORR) (risk ratio, RR: 0.92, 95% CI: 0.77–1.10, p = 0.37) and generated fewer grade 3 and 4 side effects including nausea (RR: 3.41, 95% CI: 1.67–6.96, p

INTRODUCTION: Pineal parenchymal tumors of intermediate differentiation (PPTID) represent less than 0.04% of brain tumors. Due to the rarity of this disease, there is no consensus as to appropriate treatment of this tumor. We present a patient with PPTID and our novel approach thereafter. CASE: A 34 year-old male presented with headache, nausea and vomiting, and an MRI showing a 2-cm pineal mass. Biopsy showed PPTID. He underwent whole brain radiation therapy and chemotherapy with carboplatin, bleomycin and VP-16. He showed recurrence after 5-years, after which partial tumor resection was performed and he underwent further treatment with cisplatin/melphalan and radiation. Two years later, MRI showed hydrocephalus and diffuse leptomeningeal spread with several solid tumors, which was treated with a VP shunt. After in-vitro chemosensitivity analysis, the patient was started on temozolamide. He had resolution of symptoms and radiographic masses. Eight months later, patient presented with further symptoms and thrombocytopenia. MRI showed tumor progression and cerebellar hemorrhage. The family elected not to treat and care was withdrawn. METHODS/RESULT: Tumor cells collected from CSF were grown in culture and sensitivity to chemotherapeutic agents was determined. In-vitro chemosensitivity trials showed DM-CHOC-PEN, a novel agent that is currently in phase-2 clinical trials at our institution, and temozolamide each had excellent response with 75% tumor cell death. We elected to treat the patient with temozolamide. CONCLUSION: We took a practical and rational approach of applying several low morbidity treatments to treat this patient's disease. Based off of our chemosensitivity trials, we found excellent results with DM-CHOC-PEN as well as temozolamide. We elected to treat the patient with temozolamide. With this approach, we were able to control this patient's disease for up to 8-years. In cases of rare tumors, we suggest the use of similar rational approaches to individual patients until proven treatment regimens are available.